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NPI Code Detail

MEDICARE: DR. CHRISTINE W THURSTON D. O

MEDICARE: DR. CHRISTINE W THURSTON D. O
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician323614LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1323614OTHERLALA LICENSE

General Provider Information

NPI Number : 1700173556
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTINE W THURSTON D. O
Provider Business Mailing Address
First Line : 201 SAINT ANN DR STE B
Second Line :
City : MANDEVILLE
State : LA
Zip : 70471-3472
Country : US
Telephone Number : 985-626-1717
Fax Number :
Provider Business Practice Location Address
First Line : 201 SAINT ANN DR STE B
Second Line :
City : MANDEVILLE
State : LA
Zip : 70471-3472
Country : US
Telephone Number : 985-626-1717
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2011
Last Update Date : 10/07/2020

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